Question 1

A father brings his son to the emergency department complaining that the child has a fever and severe,foul-smelling diarrhea.The child's only previous health complaint was constipation.The nurse notes abdominal distention and firmness on palpation.Which nursing action takes priority?
A) Have the father sign a consent for emergency surgery.
B) Place the child on NPO status and insert an NG tube.
C) Prepare to administer intravenous antibiotics.
D) Start an IV and provide maintenance and replacement fluids.

Accepted Answer

This child's presentation is consistent with Hirschsprung disease and enterocolitis,which is a serious complication.Although all options are appropriate,the priority is to start an IV and provide fluids.Airway,breathing,and circulation come first.

Question 2

A child in the emergency department has a suspected Meckel diverticulum.What diagnostic testing is most important for the nurse to facilitate?
A) Abdominal ultrasound
B) Complete blood count
C) Non-contrast CT scan
D) Radionuclide scintigraphy

Accepted Answer

A nuclear medicine scan,specifically radionuclide scintigraphy (Meckel scan),is the best diagnostic test for this condition.Anemia can occur in undiagnosed disease,but is nonspecific.The other two studies are not diagnostic for Meckel diverticulum.

Question 3

A mother is distraught after learning that her son has Hirschsprung disease.She asks the nurse how she could have prevented this from occurring.Which response by the nurse is most appropriate?
A) "Did you use recreational drugs during pregnancy?"
B) "How much alcohol did you consume while pregnant?"
C) "Nothing; this disease seems to be familial in origin."
D) "You probably did not get enough folic acid in your diet."

Accepted Answer

Hirschsprung disease is a familial condition,often associated with other congenital abnormalities such as trisomy 21.The nurse should assure the mother that she did not cause this problem.The other options are not appropriate.

Question 4

A school-age child is being discharged after a laparoscopic appendectomy.Which discharge teaching does the nurse provide to the child and family?
A) Allow activity as the child desires.
B) Call the surgeon for reports of pain.
C) Empty the drains twice a day.
D) Report redness or heat at the incision sites.

Accepted Answer

Discharge instructions after appendectomy include monitoring for signs of infection,which include redness and heat at the sites.Activity and eating should be progressive,especially in a younger child who might not have the ability to determine what activity is appropriate postoperatively.After a laparoscopic appendectomy,no drains will be present.Some pain is expected,and parents need teaching on pain management.

Question 5

A new nurse is caring for a toddler with failure to thrive (FTT).Which action by the new nurse would cause the preceptor nurse to intervene?
A) Collaborating with laboratory to schedule blood draws well before mealtime
B) Hiding needed medication and supplements in child's favorite food
C) Teaching parents how a child's nutrition needs differ from an adult's
D) Weighing the child at the same time each day on the same scale

Accepted Answer

Hiding medications in a child's favorite food is deleterious,because it may make the child mistrustful of the nurse and may cause the child to refuse to eat favorite foods.The preceptor should intervene and correct the new nurse taking this action.The other interventions are appropriate.

Question 6

A nurse is performing a focused abdominal assessment on a child complaining of stomach pain.Which assessment finding warrants immediate action by the nurse?
A) Complains of pain of 4 on 1-10 scale
B) Lack of rebound tenderness
C) Negative obturator sign
D) Positive heel-drop jarring test

Accepted Answer

A positive heel-drop jarring test involves having the patient stand on his or her toes for 15 seconds then drop onto the heels.Pain elicited with this assessment is indicative of appendicitis.The patient may also wince when getting off the examination table.The nurse should notify the provider immediately.Pain is nonspecific and needs treatment,but does not need immediate action.A negative obturator sign is normal,as is the lack of rebound tenderness.

Question 7

A nurse notes that a patient has a bluish discoloration of the periumbilical area.Which term will the nurse use when documenting this finding in the medical record?
A) Cullen's sign
B) Grey Turner's sign
C) Kernig's sign
D) Psoas sign

Accepted Answer

Cullen's sign is an indication of pancreatitis and is described as a bluish periumbilical discoloration.Grey Turner's sign is also an indication of pancreatitis and is a bluish discoloration of the flank.Kernig's sign is used to assess for meningitis.Psoas sign is used to assess for pancreatitis.

Question 8

A nurse is teaching a group of day-care providers about infection control.Which action does the nurse explain is the best way to prevent children from contracting diarrhea?
A) Good hand-washing practices
B) Limiting toy sharing to small groups
C) Providing less juice with sugar
D) Wearing gloves to change diapers

Accepted Answer

Good hand-washing practices are the best method to prevent acute diarrhea,and other diseases as well.The other actions may be useful,but are not nearly as vital as proper hand hygiene.

Question 9

The pediatric nurse is caring for a hospitalized child with cirrhosis who has 4+ pitting edema.Which laboratory value would the nurse correlate with the edema?
A) Albumin: low
B) Cholesterol: low
C) Prothrombin time: high
D) White blood cell count: high

Accepted Answer

All of these laboratory values are typical in a patient with cirrhosis.However,albumin deficiency causes fluid to be lost from the vascular space,leading to edema.

Question 10

A patient has pancreatitis.Which daily laboratory test will the nurse review as a priority for this patient?
A) Amylase
B) C-reactive protein
C) Lipase
D) White blood cell count

Accepted Answer

Although all options are routine laboratory tests for the patient with pancreatitis,lipase is the best indicator of pancreatic function,as it stays elevated longer than amylase.
 Level Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Assessment

Question 11

A pediatric clinic nurse is educating parents about an important primary prevention measure for hepatitis A. Which topic does the nurse include in the teaching session? 
A) Genetic counseling
B) Immune globulin
C) Immunization
D) Oatmeal baths

Accepted Answer

Primary prevention measures are those that prevent the onset of disease.Immunizations are a prime example of primary prevention.Immune globulin is given to children after an exposure,and although it is considered a primary prevention measure,it is not as important as vaccination.Genetic counseling is not indicated because hepatitis is a viral disease.Oatmeal baths would be suggested for a child who already has hepatitis and pruritus.

Question 12

A pediatric nurse is teaching the family of a child with celiac disease about necessary dietary modifications to manage the disease.Which information does the nurse include in the teaching session?
A) Eliminate all sources of corn.
B) High-calorie, high-protein foods are preferred.
C) Lactose restriction may be needed.
D) Rye and wheat must be avoided.
E) Watch for hidden sources of gluten.

Accepted Answer

The treatment of celiac disease is a gluten-free diet.Because gluten is found mainly in wheat and rye,and to a smaller extent in barley and oat products,it is recommended that they be eliminated from the diet.Corn,rice,and millet are grains that are allowed in the diet.General dietary guidelines include high-protein,high-calorie foods.In severe cases,temporary lactose restrictions may be needed.Gluten is often hidden in food products.

Question 13

A nurse is conducting prenatal classes and teaches about common congenital defects.A pregnant woman asks how to prevent Meckel diverticulum,which she had when she was born.What information does the nurse provide to this pregnant woman?
A) Adequate intake of folic acid will prevent this condition from developing.
B) Avoid second-hand smoke, pollution, and exposure to heavy metals.
C) Early initiation of breastfeeding after birth is a preventative measure.
D) This condition is not preventable, but good prenatal care is still important.

Accepted Answer

There are no preventative measures for Meckel diverticulum,but the nurse should still encourage the woman to maintain good prenatal care.

Question 14

After surgical correction of a Meckel diverticulum,what nursing action is the most important?
A) Administration of total parenteral nutrition
B) Care of a nasogastric tube and oral care
C) Referral to a dietician for low-residue diet
D) Teaching parents and child colostomy care

Accepted Answer

Postoperatively after a Meckel diverticulum surgery,the child will have a nasogastric tube in place.The nurse needs to provide proper care of this tube,including good oral care.The other interventions are not warranted.

Question 15

A child has been admitted to the hospital with acute diarrhea.Which assessment finding by the nurse would indicate that goals for the priority nursing diagnosis have been met?
A) No stooling for 4 hours
B) Perineal skin intact
C) Stable weight for 2 days
D) White blood cell count normal

Accepted Answer

The priority for a child with diarrhea is to maintain or restore fluid volume.Weight is the most sensitive noninvasive indicator of fluid status,and a stable weight over 2 days indicates hemodynamic stability.Alterations in skin integrity may or may not be present,but if present,they would not take priority over fluid balance.Not having a stool for 4 hours does not indicate resolution of the priority problem.WBC may be normal in cases of diarrhea,but even if abnormal,the WBC does not address fluid status.

Question 16

The nurse explains to the nursing student that lactose is hydrolyzed into glucose and galactose in which organ?
A) Gallbladder
B) Large intestine
C) Small intestine
D) Stomach

Accepted Answer

Lactose is hydrolyzed into glucose and galactose in the small intestine through the action of the enzyme lactase.

Question 17

A nurse has been working with a teenager who has celiac disease.Which statement by the patient indicates that goals for an important diagnosis have been met?
A) "Gluten is obvious and easy to find in food products."
B) "I am gaining weight and I have more energy."
C) "Rice was my favorite; I hated to give that up."
D) "When my symptoms go away I can eat wheat again."

Accepted Answer

Celiac disease causes malabsorption of nutrients.The child who is gaining weight and is more energetic is most likely following the required diet.Because knowledge of dietary management is a major goal for patients with this disease,this statement shows that this goal has been met.The other statements are incorrect.Gluten is often hidden in foods.Rice is allowed.Following the gluten-free diet is required for life.

Question 18

A parent calls the pediatric clinic to make an appointment for her child who complains of periumbilical pain that has progressed to right lower quadrant pain.Later the parent calls to cancel the appointment,stating that the pain went away spontaneously after the child used a heating pad.What action by the nurse is most appropriate?
A) Ask the parent if the child has diarrhea or a fever.
B) Encourage the parent to keep the appointment anyway.
C) Instruct the parent to take the child to an emergency department.
D) Reassure the parent she can bring the child in if the pain returns.

Accepted Answer

This child has the classic pain presentation of appendicitis.Appendicitis pain that resolves spontaneously is often indicative of perforation.The child needs to be seen in an emergency department.The other actions are not appropriate at this time.

Question 19

A nurse is caring for a child with irritable bowel syndrome (IBS)who has severe abdominal cramping.Which medication would the nurse question for this child?
A) Bisacodyl (Dulcolax)
B) Hyoscyamine (Levsin)
C) Phenobarbital (Donnatal)
D) Scopolomine (Isopto)

Accepted Answer

Levsin,Donnatal,and Isopto are all anti-spasmodics.Dulcolax is a stool softener.

Question 20

A 13-year-old child has been admitted for acute pancreatitis.The parents want to know how the child contracted this disease.Which response by the nurse is the most appropriate?
A) "Has your child been exposed to pancreatitis?"
B) "In most cases we don't find the cause."
C) "Microliths are a common causative factor."
D) "Your child is probably drinking alcohol."

Accepted Answer

In children,the causative factors for pancreatitis are different than those seen in adults,who commonly develop pancreatitis secondary to alcohol abuse.Most cases of pediatric pancreatitis are idiopathic,which means the cause is not clear.The nurse's best reply is this one.Although microliths can cause pancreatitis,this is less common,and this response contains too much medical jargon to give the parents good information.The other two responses are inaccurate.

Quiz 24: Caring for the Child With a Gastrointestinal Condition

A father brings his son to the emergency department complaining that the child has a fever and severe,foul-smelling diarrhea.The child's only previous health complaint was constipation.The nurse notes abdominal distention and firmness on palpation.Which nursing action takes priority?

A child in the emergency department has a suspected Meckel diverticulum.What diagnostic testing is most important for the nurse to facilitate?

A mother is distraught after learning that her son has Hirschsprung disease.She asks the nurse how she could have prevented this from occurring.Which response by the nurse is most appropriate?

A school-age child is being discharged after a laparoscopic appendectomy.Which discharge teaching does the nurse provide to the child and family?

A new nurse is caring for a toddler with failure to thrive (FTT) .Which action by the new nurse would cause the preceptor nurse to intervene?

A nurse is performing a focused abdominal assessment on a child complaining of stomach pain.Which assessment finding warrants immediate action by the nurse?

A nurse notes that a patient has a bluish discoloration of the periumbilical area.Which term will the nurse use when documenting this finding in the medical record?

A nurse is teaching a group of day-care providers about infection control.Which action does the nurse explain is the best way to prevent children from contracting diarrhea?

The pediatric nurse is caring for a hospitalized child with cirrhosis who has 4+ pitting edema.Which laboratory value would the nurse correlate with the edema?

A patient has pancreatitis.Which daily laboratory test will the nurse review as a priority for this patient?

A pediatric clinic nurse is educating parents about an important primary prevention measure for hepatitis A. Which topic does the nurse include in the teaching session?

A pediatric nurse is teaching the family of a child with celiac disease about necessary dietary modifications to manage the disease.Which information does the nurse include in the teaching session?

A nurse is conducting prenatal classes and teaches about common congenital defects.A pregnant woman asks how to prevent Meckel diverticulum,which she had when she was born.What information does the nurse provide to this pregnant woman?

After surgical correction of a Meckel diverticulum,what nursing action is the most important?

A child has been admitted to the hospital with acute diarrhea.Which assessment finding by the nurse would indicate that goals for the priority nursing diagnosis have been met?

The nurse explains to the nursing student that lactose is hydrolyzed into glucose and galactose in which organ?

A nurse has been working with a teenager who has celiac disease.Which statement by the patient indicates that goals for an important diagnosis have been met?

A nurse is caring for a child with irritable bowel syndrome (IBS) who has severe abdominal cramping.Which medication would the nurse question for this child?

A 13-year-old child has been admitted for acute pancreatitis.The parents want to know how the child contracted this disease.Which response by the nurse is the most appropriate?